Abstract

The U.S. Census shows that African Americans make up 13% of the U.S. population and have higher mortality rates than whites but they only account for 8.9% of the hospice population. This qualitative study examined variables needed to expand hospice services among African Americans, and whether race-based historical injustice needed to be addressed with patients at end-of-life. The investigation is based on the perspectives of seven African American hospice patients receiving in- and out-patient services through one hospice program in the Southeast, U.S. Hospice usage was considered from a relational perspective whereby the cultures of both African Americans and hospice were examined in order to locate the points of both impasse and opportunity. Participants were asked about end-of-life planning, family, spirituality, mistrust, race, values and beliefs surrounding death and comfort so that biases in hospice care which are both overt and insidious would be exposed. The findings of the research showed that verbally addressing race-based historical injustice was not a necessary component of end-of-life care. Participants reported "trust and care" between workers and patients, which was connected to sincerity, workers' ability to meet and exceed patient needs and the honoring of spiritual beliefs. Participants recommended increasing outreach efforts among African Americans and physicians proved to be hugely influential in informing African Americans of hospice services. Two key findings emerged from this study: (1) lack of information regarding hospice costs and availability of its services; and (2) the need for hospice facilities located within African American communities.